Products For The Difficult Airway - Medial

Products For The Difficult Airway

Fig. 1.

Anesthesiology, V 98, No 5, May 2003

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ContentsMelker Universal Emergency Cricothyrotomy Catheter Set . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Melker Emergency Cricothyrotomy Catheter Sets – Cuffed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Melker Emergency Cricothyrotomy Catheter Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Melker Emergency Cricothyrotomy Catheter Set – Special Operations . . . . . . . . . . . . . . . . . . 7

Arndt Emergency Cricothyrotomy Catheter Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Emergency Transtracheal Airway Catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Enk Oxygen Flow Modulator Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Wadhwa Emergency Airway Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Cook Retrograde Intubation Sets with Rapi-Fit® Adapters . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Cook Airway Exchange Catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Cook Airway Exchange Catheters EF – Extra Firm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Aintree Intubation Catheter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Frova Intubating Introducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Enk Fiberoptic Atomizer Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Management of the Difficult Airway CD-ROM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Fundamentals of Airway Management Techniques – A Color Atlas . . . . . . . . . . . . . . . . . . . . 18

Use of Rapi-Fit® Adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Videotapes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

CD-Rom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Posters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Slides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

4 PRODUCTS FOR DIFFICULT AIRWAY

MELKER UNIVERSAL EMERGENCY CRICOTHYROTOMY CATHETER SET

Used for emergency airway access when conventional endotracheal intubation cannot be performed.

• Airway access is achieved utilizing percutaneous entry(Seldinger) or surgical technique via the cricothyroid membrane.

Supplied sterile in peel-open packages. Intended for one-time use.

SET AIRWAY CATHETER GlobalORDER ProductNUMBER1 Inner Diameter Length Number

C-TCCSB-500-UNI 5 mm 9 cm G32193

Set includes one airway catheter (shown) to be used with either blunt or tapered dilator.

COMPONENTS USED FOR SELDINGER TECHNIQUE

SCALPEL

SYRINGE

BLUNT CURVED DILATOR

Radiopaque appropriate size and length

INTRODUCER NEEDLE

18 gage appropriate length

AMPLATZ EXTRA STIFF WIRE GUIDE

.038 inch diameter stainless steel, appropriate length with flexible tip

TFE CATHETER INTRODUCER NEEDLE


INFLATED

AIRWAY CATHETER

Polyvinylchloride

TRACHEAL HOOK

TROUSSEAU

DILATOR

#11 SAFETY SCALPEL

TAPERED CURVED DILATOR


COMPONENTS USED FOR SURGICAL TECHNIQUE

1Set consists of items shown above and drape, gauze pads, povidone-iodine swabsticks and solution, needle holder cup and cloth tracheostomy tape strip for fixation of airway catheter.

PRODUCTS FOR DIFFICULT AIRWAY 5

MELKER EMERGENCY CRICOTHYROTOMY CATHETER SETSCUFFED

Used for emergency airway access when conventionalendotracheal intubation cannot be performed.

• Airway access is achieved utilizing percutaneous entry(Seldinger) technique via the cricothyroid membrane.

• Subsequent dilation of the tract and tracheal entrancesite permits passage of the emergency airway.

• Catheter is cuffed to protect and control airway.

• Airway catheter has radiopaque stripe.


SCALPEL

SYRINGE

CURVED DILATOR


INTRODUCER NEEDLE


INFLATED

AIRWAY CATHETER

Polyvinylchloride

DEFLATED

AIRWAY CATHETER

ON END VIEW





SET AIRWAY CATHETER GlobalORDER ProductNUMBER1 Inner Diameter Length Number Remarks

C-TCCSB-500 5 mm 9 cm G29432

C-TCCSB-500-SPOPS 5 mm 9 cm G26924 Custom packaged in slip peel-pouch design for easy transportation. Dilator is pre-inserted into airway catheter. Includes two 18 gage introducer needles, 5 cm and 7 cm.

1Sets consist of items shown above and cloth tracheostomy tape strip for fixation of airway catheter.

Patent Number 4,677,978


MELKER EMERGENCY CRICOTHYROTOMY CATHETER SETS

Used for emergency airway access when endotrachealintubation cannot be performed.





SYRINGE

INTRODUCER NEEDLE


CURVED DILATOR




AIRWAY

CATHETER

PolyvinylchlorideSCALPEL

ON END VIEW

OF AIRWAY CATHETER

EMERGENCY AIRWAY ACCESS ASSEMBLY

POSITIONED OVER WIRE GUIDE


.038 inch diameter stainless steel appropriate length with flexible tip

SET AIRWAY CATHETER GlobalORDER ProductNUMBER1 Inner Diameter Length Number

C-TCCS-600 6 mm 7.5 cm G04652

C-TCCS-400 4 mm 4.2 cm G06246

C-TCCS-350 3.5 mm 3.8 cm G06245

1Sets consist of items shown above and cloth tracheostomy tape strip for fixation of airway catheter.



MELKER EMERGENCY CRICOTHYROTOMY CATHETER SETSPECIAL OPERATIONS

Used for emergency airway access when endotrachealintubation cannot be performed.




• Custom packaged in slip peel-pouch design for easy transportation.

• Combines 4.0 mm catheter with a 6.0 mm catheter in onepackage thereby reducing the number of kits needed in the field.

• Dilators are pre-inserted into airway catheters.


SYRINGE

INTRODUCER NEEDLE

18 gage 5 cm long

CURVED

DILATOR

Radiopaque appropriate

size and length

CURVED

DILATOR

Radiopaque appropriate

size and length

INTRODUCER NEEDLE

18 gage 7 cm long

LARGE AIRWAY

CATHETER

Polyvinylchloride

SMALL AIRWAY

CATHETER

PolyvinylchlorideSCALPEL

ON END VIEW

OF AIRWAY

CATHETER



SET SMALL AIRWAY CATHETER LARGE AIRWAY CATHETER GlobalORDER ProductNUMBER1 Inner Diameter Length Inner Diameter Length Number

C-TCCS-600-SPOPS 4 mm 4.2 cm 6 mm 7.5 cm G10699

1Set consists of items shown above and cloth tracheostomy tape strip for fixation of airway catheter.



ARNDT EMERGENCY CRICOTHYROTOMY CATHETER SET

Used for emergency airway access when conventional endotracheal intubation and ventilation cannot be performed.




SYRINGE

INTRODUCER NEEDLE

18 gage appropriate lengthTFE CATHETER INTRODUCER NEEDLE



.038 inch diameter stainless steel appropriate length with flexible tip

AIRWAY CATHETER ASSEMBLY

Reinforced FEP catheter and radiopaque dilator

CONNECTING TUBE

For use with ventilatory device

AIRWAY CATHETER NEEDLESET GlobalORDER Inner ProductNUMBER1 Diameter Length Gage Number

C-DTJV-9.0-6.0-ARNDT 3 mm 6 cm 18 G08251

1Set consists of items shown above, sterile water, scalpel and cloth tracheostomy tape strip for fixation of airway catheter.

15 mm

Connector

15 mm

Connector

Male

Luer Lock

Connector

Airway

Catheter

Dilator

Female Luer Lock

Connector


EMERGENCY TRANSTRACHEAL AIRWAY CATHETERS

Used for emergency airway access when conventionalendotracheal intubation cannot be performed. Suppliedsterile in peel-open packages. Intended for one-time use.

CATHETER NEEDLE

Reinforced FEP catheter

CATHETER NEEDLE GlobalORDER French Inner ProductNUMBER Size Diameter Length Gage Number

C-DTJV-6.0-5.0-BTT 6.0 2 mm 5.0 cm 15 G10338

C-DTJV-6.0-7.5-BTT 6.0 2 mm 7.5 cm 15 G09413


ENK OXYGEN FLOW MODULATOR SETS

Used with emergency transtracheal catheter ventilation whenconventional ventilation by mask or endotracheal tube cannotbe performed. The device allows manually controlled oxygenflow. Please refer to product insert prior to use. Suppliedsterile in peel-open packages. Intended for one-time use.

CATHETER NEEDLESET GlobalORDER French Inner ProductNUMBER Size Length Diameter Gage Remarks Number

C-EFMS-100 6.0 7.5 cm 2 mm 15 SET includes items shown above. G12398

C-EFMS-101 6.0 5.0 cm 2 mm 15 SET includes items shown above. G13145

Transtracheal

Catheter

Connection

SYRINGE

CATHETER NEEDLE

Reinforced FEP catheter

ENK OXYGEN FLOW MODULATOR

Connecting

Tube

Connecting Tube


CRICOTHYROTOMY CATHETER NASOPHARYNGEAL AIRWAY CATHETER GlobalORDER French Inner ProductNUMBER Size Length Diameter Length Number

C-WEAD-100 9.0 6 cm 7.0 mm 9.5 cm G26948

WADHWA EMERGENCY AIRWAY DEVICE

Used for emergency airway access when conventional endotracheal intubation cannot be performed.

• Components of the set include nasopharyngeal airway catheter,cricothyrotomy catheter and 15 mm adapter.

• This device and all of its components require pre-assembly andonce assembled are non-sterile.

Intended for one-time use.

NASO-PHARYNGEALAIRWAY

CRICOTHYROTOMYCATHETER

CRICOTHYROTOMYCATHETER WADHWA EMERGENCY AIRWAY DEVICE

NASO-PHARYNGEALAIRWAY

WADHWA EMERGENCY AIRWAY DEVICE

NASOPHARYNGEAL AIRWAY CATHETERCRICOTHYROTOMY CATHETER

ASSEMBLED AIRWAY DEVICE

15 mm ADAPTER



COOK RETROGRADE INTUBATION SETS WITH RAPI-FIT® ADAPTERS

Used to assist in the placement of an endotracheal tube duringdifficult airway access procedures.

• Initial access utilizing the Seldinger technique via the cricothyroidmembrane permits retrograde (cephalad directed) placement of awire guide exiting orally or nasally.

• Antegrade introduction of a hollow guiding catheter with distal side-ports and Rapi-Fit® Adapters allows patient oxygenation and facili-tates placement of an endotracheal tube.


15 CM35 CM 30 CM 20 CM

SYRINGE

POSITIONING MARK POSITIONING MARK

NEEDLE HOLDER

GUIDING CATHETER

Radiopaque

INTRODUCER NEEDLE



18 gage 5 cm long

STRAIGHT AND CURVED SAFE-T-J® DOUBLE FLEXIBLE TIPPED WIRE GUIDE

Stainless steel

RAPI-FIT® ADAPTER

Plastic

(15 mm connector)

RAPI-FIT® ADAPTER

Plastic

(Luer lock connector)

CATHETER WIRE GUIDE SET Use with GlobalORDER French Endotracheal Tube ProductNUMBER Size Length Diameter Length Tip with Inner Diameter Number

C-RETRO-6.0-50-38J-110 6.0 50 cm .038 inch 110 cm straight and 2.5 mm or larger G09727 3 mm “J”

C-RETRO-11.0-70-38J-110 11.0 70 cm .038 inch 110 cm straight and 4.0 mm or larger G07647 3 mm “J”

C-RETRO-14.0-70-38J-110-CAE 14.0 70 cm .038 inch 110 cm straight and 5.0 mm or larger G10554 3 mm “J”

Replacement Wire Guide

C-DOC-38-110-0-3-RETRO .038 inch 110 cm straight and G07622 3 mm “J”


20 CM25 CM

CATHETER

RadiopaqueRAPI-FIT® ADAPTER

Plastic

(15 mm connector)

RAPI-FIT® ADAPTER

Plastic


COOK AIRWAY EXCHANGE CATHETERS

Used for uncomplicated, atraumatic endotracheal tube exchange.

• Use of removable Rapi-Fit® Adapter permits use of ventilatorydevice if necessary during exchange procedure.

• Through-lumen design of catheter with distal sideports ensuresadequate air flow.

• Blunt tip of catheter is atraumatic to internal structures.

• Centimeter marks facilitate accurate placement with shortenedendotracheal tubes.



Use in Replacement of GlobalORDER French Inner Endotracheal Tube ProductNUMBER Size Length Diameter with Inner Diameter Number

For Use With Single Lumen Endotracheal Tubes

C-CAE-8.0-45 8.0 45 cm 1.6 mm 3 mm or larger G07833


C-CAE-14.0-83 14.0 83 cm 3 mm 5 mm or larger G07873



5 CM�10 CM�15 CM�20 CM�

CATHETER

Radiopaque

RAPI-FIT® ADAPTER

Plastic

(15 mm connector)

RAPI-FIT® ADAPTER

Plastic


COOK AIRWAY EXCHANGE CATHETERS EFEXTRA FIRM


• Extra firm catheter facilitates exchange of double lumen tubes.


• Through-lumen design of catheter with distal sideports ensuresadequate air flow.


• Centimeter marks facilitate accurate placement with shortenedendotracheal tubes.




For Use With Double Lumen Endotracheal Tubes

C-CAE-11.0-100-DLT-EF 11.0 100 cm 2.3 mm 4 mm or larger G13348

C-CAE-14.0-100-DLT-EF 14.0 100 cm 3 mm 5 mm or larger G13349


30 CM35 CM 5 CM25 CM

CATHETER

Radiopaque

RAPI-FIT® ADAPTER

Plastic

(15 mm connector)

RAPI-FIT® ADAPTER

Plastic


AINTREE INTUBATION CATHETER



• Catheter has larger 4.7 mm lumen.

• Through-lumen design of catheter with distal sideportsensures adequate air flow.


• Centimeter marks facilitate accurate placement withshortened endotracheal tubes.




C-CAE-19.0-56-AIC 19.0 56 cm 4.7 mm 7 mm or larger G10789


CATHETER Use in Replacement of GlobalORDER French Inner Endotracheal Tube ProductNUMBER Size Length Diameter with Inner Diameter1 Number

With Stiffening Cannula

C-CAE-8.0-35-FII 8.0 35 cm 1.6 mm 3 mm or larger G12591

C-CAE-14.0-65-FII 14.0 65 cm 3 mm 6 mm or larger G11915

Without Stiffening Cannula

C-CAE-14.0-65-FI 14.0 65 cm 3 mm 6 mm or larger G13307

FROVA INTUBATING INTRODUCERS

Used to facilitate endotracheal intubation and to allow simple endotracheal tube exchange. Use of removable Rapi-Fit® Adapter permits use of ventilatory device if necessary during exchange procedure. Supplied sterile in peel-open packages. Intended for one-time use.

5 CM10 CM35 CM40 CM

STIFFENING CANNULA

(For use with 14.0 French introducer)

STIFFENING CANNULA

(For use with 8.0 French introducer)

RAPI-FIT® ADAPTER

Plastic

(15 mm connector)

RAPI-FIT® ADAPTER

Plastic


CATHETER INTRODUCER

Radiopaque

1Endotracheal tube not included.



ENK FIBEROPTIC ATOMIZER SET

Used for atomizing local anesthetics in connection with flexiblefiberoptic intubation techniques. The Enk Fiberoptic Atomizer Setprovides adequate topical anesthesia by atomizing small doses oflocal anesthetics through the working channel of the bronchoscope using flow oxygen.

• Reduced doses of anesthetics together with the atomizer effect enhance patient comfort.

• Repeated administration of local anesthetic solutions and flowoxygen ("spray as you go") keeps the front lens clear duringbronchoscope advancement.


SET GlobalORDER ProductNUMBER Number

C-EFNS-100 G27286

1 ml SYRINGE (2)INTRODUCER

CATHETER

CONNECTING

TUBE

ATOMIZER

Flow control opening

CONNECTING

TUBE


MANAGEMENT OF THE DIFFICULT AIRWAY CD-ROM

Objectives:

• A practical and concise introduction to managementof the difficult airway.

Topics Include:

• An interactive tutorial computer program with text, diagrams, pictures and video.

• Planning and recognition of many potential problems.

• Many routine/emergency management techniques.

Minimum System Requirements:

• 16MB RAM

• 640 x 480 pixel color display with 256 colors

• Sound card and speakers

• CD-ROM drive

• Microsoft Windows 95; Apple system 7.5 or higher

• Quicktime v2.5 or higher

GlobalORDER ProductNUMBER Number

C-CD-AIRWAY-1 G09848

FUNDAMENTALS OF AIRWAY MANAGEMENT TECHNIQUESA COLOR ATLAS (A TWO VOLUME SET) BY VIJAYALAKSHI U. PATIL, M.D.

Objectives:

• The atlas is comprehensive in discussing the basic approachto airway management.

• The volumes describe how to perform each technique in detail and offers solutions to clinical problems and emergencies.

About Dr. Patil:

• Dr. Patil is the recipient of numerous awards for exhibits on airway management equipment, techniques and teaching models at national and international conferences.

Ordering Information:

• To order this book please visit the following website: www.lotuspublications.com.


REFERENCESP. Safar, J. Penninckx: “Cricothyroid Membrane Puncture with Special Cannula,” Anesthesiology, 28 (1967), 943-948.

G. Frova: “Comparison Between Two Choices in Grade III Laryngoscopic View Difficulty,” British Journal of Anaesthesia, 76 (1996), 54.

J. L. Parmet, S. Metz, A. J. Schwartz: “Anesthesiology Issuesin General Surgery: Retrograde Endotracheal Intubation: An Underutilized Tool for Management of the Difficult Airway,” Contemporary Surgery, 49 (1996).

E. P. Loudermilk, M. Hartmannsgruber, D. P. Stolzfus, P. B. Langevin: “A Prospective Study of the Safety of Tracheal Extubation Using a Pediatric Airway Exchange Catheter for Patients with a Known Difficult Airway,” Chest, 111 (1997), 1660-1665.

J. L. Benumof: “Airway Exchange Catheters for Safe Intubation, The Clinical and Scientific Details That Make the Concept Work,” Chest, 111 (1997), 1483-1486.

G. A. Arndt, J. Topp, J. Hannah, T. S. McDowell, A. Lesko: “Intubation via the LMA Using a Cook Retrograde Intubation Kit,” Canadian Journal of Anaesthesia, 3 (1998), 257-260.

D. Enk, H. Busse, A. Meissner, H. Van Aken: “A New Devicefor Oxygenation and Drug Administration by Transtracheal Jet Ventilation,” Anesthesia & Analgesia, 86 (1998), (2S), S203.

J. D. Tobias: “Intubations Through the Laryngeal Mask Airway Over an Endotracheal Tube Exchange Guide Using End-tidal Carbon Dioxide Monitoring,” The American Journal of Anesthesiology, November-December, (1997), 308-310.

M. Hawkins, E. O’Sullivan, P. Charters: “Fibreoptic Intubation Using the Cuffed Oropharyngeal Airway and Aintree Intubation Catheter,” Anaesthesia, 53 (1998), 891-894.

D.P.L. Atherton, E. O’Sullivan, D. Lowe, P. Charters: “A Ventilation-Exchange Bougie for Fibreoptic Intubations With the Laryngeal Mask Airway,” Anaesthesia, 21 (1996), 1123-1126.

ACKNOWLEDGEMENTSG. A. Arndt, M.D., Department of Anesthesiology, University of Wisconsin Medical School, Madison, Wisconsin.

R. J. Melker, M.D., Ph.D., Division of Emergency Medicine, Shands Hospital, University of Florida, Gainesville, Florida.

G. Frova, M.D., Department of Anaesthesia and Intensive Care, Spedali Civili, Brescia, Italy.

C. Ward, M.D., Scripps Green Hospital, La Jolla, California.

D. Enk, M.D., University of Münster, Münster, Germany.

VIDEOTAPESC-VC-18 INSERTION OF THE MELKER EMERGENCY

CRICOTHYROTOMY CATHETER

AUTHOR: R. Melker, Shands Hospital, Universityof Florida, Gainesville, Florida.

C-VC-43 COOK RETROGRADE INTUBATION SETS

AUTHOR: W. Rosenblatt, Yale-New Haven Hospital, Yale University, New Haven, Connecticut.

CD-ROMC-MCD-TCS803 INSERTION OF THE MELKER

EMERGENCY CRICOTHYROTOMY CATHETER

AUTHOR: R. Melker, Shands Hospital, Universityof Florida, Gainesville, Florida.

TO ATTACH

Position on catheter and push white collar forward and lock into position.

TO REMOVE

Pull white collar back to release and remove from catheter.

1For use of Rapi-Fit® Adapter with 15 mm connector or Rapi-Fit® Adapter with Luer lock connector.

POSTERSCook Airway Exchange Catheters (C-P-CAE998)

Melker Emergency Cricothyrotomy Catheter Sets

(C-P-TCCS998)

Cook Retrograde Intubation Sets (C-P-RETRO998)

Seldinger Technique (C-P-ST899)

Available upon request from Cook Critical Care.

SLIDESInstructional slide series on the use of products

for the difficult airway.

Available upon request from Cook Critical Care.

USE OF RAPI-FIT® ADAPTER1

Distributed by:

COOK MEDICAL INCORPORATEDP.O. Box 4195, Bloomington, IN 47402-4195 U.S.A.Phone: 812 339-2235, Toll Free: 800 457-4500, Toll Free Fax: 800 554-8335

COOK (CANADA) INC.111 Sandiford Drive, Stouffville, Ontario, L4A 7X5 CANADAPhone: 905 640-7110, Toll Free: 800 668-0300

WILLIAM A. COOK AUSTRALIA PTY. LTD.Brisbane Technology Park, 12 Electronics Street, Eight Mile PlainsBrisbane, QLD 4113 AUSTRALIA, Phone: +61 7 38 41 11 88

WILLIAM COOK EUROPE ApSSandet 6, DK-4632, Bjaeverskov, DENMARK, Phone: +45 56 86 86 86

© COOK INCORPORATED 2005 C-DAB705

Interventional Critical Care Products

www.cookcriticalcare.com

Documents

Products For The Difficult Airway - Medial